Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2017; 23(32): 5936-5944
Published online Aug 28, 2017. doi: 10.3748/wjg.v23.i32.5936
Novel predictors for lymph node metastasis in submucosal invasive colorectal carcinoma
Kwangil Yim, Daeyoun David Won, In Kyu Lee, Seong-Taek Oh, Eun Sun Jung, Sung Hak Lee
Kwangil Yim, Eun Sun Jung, Sung Hak Lee, Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Daeyoun David Won, In Kyu Lee, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Seong-Taek Oh, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea
Author contributions: Yim K, Won DD contributed equally to this work; Yim K, Won DD and Lee SH designed experiments; Yim K, Won DD, Lee IK, Oh ST, Jung ES and Lee SH performed research; Yim K and Won DD analyzed data; and Yim K and Lee SH wrote the paper.
Conflict-of-interest statement: The authors do not have any conflicts of interest to disclose.
Institutional review board statement: This study was approved by the Institutional Review Board of the Catholic University of Korea, Seoul St. Mary’s Hospital, College of Medicine (KC16RISI0817).
Informed consent statement: Written informed consent was obtained by all patients.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sung Hak Lee, MD, PhD, Assistant Professor, Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 137-701, South Korea. hakjjang@catholic.ac.kr
Telephone: +82-2-22581617 Fax: +82-2-22581627
Received: May 24, 2017
Peer-review started: May 26, 2017
First decision: June 23, 2017
Revised: July 5, 2017
Accepted: August 8, 2017
Article in press: August 8, 2017
Published online: August 28, 2017
Processing time: 95 Days and 20.1 Hours
Abstract
AIM

To evaluate a novel grading system to predict lymph node metastasis (LNM) in patients with submucosal invasive colorectal carcinoma (SICRC).

METHODS

We analyzed the associations between LNM and various clinicopathological features in 252 patients with SICRC who had undergone radical surgery at the Seoul Saint Mary’s hospital between 2000 and 2015.

RESULTS

LNM was observed in 31 patients (12.3%). The depth and width of the submucosal invasion, lymphatic invasion, tumor budding, and the presence of poorly differentiated clusters (PDCs) were significantly associated with the incidence of LNM. Using multivariate analysis, the receiver operating characteristic curvewas calculated and the area under curve (AUC) was used to compare the ability of the different parameters to identify the risk of LNM. The most powerful clinicopathological parameter for predicting LNM was lymphatic invasion (difference AUC = 0.204), followed by the presence or absence of tumor budding (difference AUC = 0.190), presence of PDCs (difference AUC = 0.172) and tumor budding graded by the Ueno method (difference AUC = 0.128).

CONCLUSION

Our results indicate that the tumor budding and the depth multiplied by the width measurements of submucosal invasion can provide important information for patients with SICRC.

Keywords: Colorectal cancer; Neoplasm invasion; Lymph node; Metastasis

Core tip: The appropriacy of endoscopic resection for patients with submucosal invasive colorectal carcinoma (SICRC) is still questionable. Therefore, highly precise predictors of lymph node metastasis (LNM) are needed to optimize the outcome of treatments for SICRC. We determined the value of a novel grading system based on histopatholological parameters to predict LNM in patients with SICRC. Our results indicate that the presence or absence of tumor budding and the depth multiplied by the width measurements of the submucosal invasion can provide important information regarding the treatment options for patients with SICRC.